MEDICARE: MS. GOOLRUKH ADI VAKIL MA, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF 47460	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891994109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GOOLRUKH ADI VAKIL MA, MS

Provider Business Mailing Address
First Line	:	472 UNIVERSITY AVE
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94301
Country	:	US
Telephone Number	:	415-845-8519
Fax Number	:	650-473-1744

Provider Business Practice Location Address
First Line	:	472 UNIVERSITY AVE
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94301-1812
Country	:	US
Telephone Number	:	415-845-8519
Fax Number	:	650-473-1744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/20/2007

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